• Kevin Cast

Copay accumulator solutions: the good, the bad, and the ugly

The pharmaceutical marketplace is abuzz with speculation surrounding copay accumulators, how they will impact revenues and volumes, and most urgently, what to do about them. We’ve met with countless clients seeking solutions, spoken with parties on both sides, and contributed to the ongoing conversation.

At the end of the day, on one side, pharma wants to do whatever they can to help patients get and stay on therapy, and on the other side, payers want patients to be accountable for their overall healthcare spend. We’re all left wondering if ever the two shall meet.

Is there a real solution? A true means of solving or dealing with this difficult situation?

Yes, there is. But first, it’s important to understand the current landscape.

The good

  • A lot of energy in the marketplace is focused on finding viable solutions with multiple companies and vendors developing new tactics and tools to manage the current copay accumulators employed by the PBMs.

  • The PBMs haven’t closed their doors to collaborative conversation. The right people with the right connections are having meaningful, effective discussions about how to move forward in mutually beneficial ways on case-by-case bases.

The bad

  • The copay accumulator “solutions” we see today are capable of dealing with this difficult situation, but they are far from solving the problem. A true solution would not subvert the established healthcare system but would work to change the root problem.

  • Programs that keep patients from realizing the true price of a drug will never appease payers.

  • Choosing to not abide by payer rules is simply not a sustainable way to do business.

  • In funding copay accumulator “solutions,” incremental dollars are still coming out of pharma’s pockets. Sometimes, that can add up to more than would be lost without a program in place.

The ugly

  • Current solutions such as debit cards work on a BIN. These can be tracked, traced, and reversed, resulting in an undesirable and embarrassing patient experience.

  • Payers can proactively reach out to patients to ask if copay cards were used. Patients are left in a position of admitting that they circumvented the system or committing insurance fraud if they lie.

  • Copay programs may help patients get on your drug today, but they are far from helping with a patient’s overall healthcare journey. Continuing on this path is feeding the problem, not working toward the solution.

The best solution today

During all of our conversations and collaborations on the topic of copay accumulators, one theme is universally agreed upon: copay reform is a must. A solution that focuses on truly helping the appropriate patient initiate and maintain therapeutic treatment is in more demand than ever.

As players on both sides of the copay accumulator fence work toward that goal, pharma needs viable solutions NOW to deliver on goals and projections. Such solutions aren’t something you can buy off a shelf because customized, negotiated, collaborative approaches are the only solutions truly offering long-term viability.

If your organization needs that type of solution, Archbow can help. We’re leveraging our industry experience and connections to build sustainable copay accumulator solutions unique to individual products and patient populations. Contact us today to get started.